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目的评价硬腭黏膜移植联合眶周皮瓣转移治疗因机械伤、眼睑恶性肿瘤切除术后眼睑全层缺损的疗效,设计回顾性病例系列。研究对象13例(13眼)因机械伤或眼睑恶性肿瘤切除术后眼睑全层缺损患者:方法对13例患者行白体硬腭黏膜移植联合眶周皮瓣转移术。记录手术前、后患者的睑裂长度、睑裂高度、睑闭合不全的程度,泪膜破裂时间,SchirmerⅠ试验和角膜荧光素染色积分,术后半年睑缘切开时取移植的硬腭黏膜进行组织学检查。随访8个月以上:主要指标手术效果、泪膜破裂时间、SchirmerⅠ试验和角膜荧光素染色积分、移植后硬腭黏膜的组织学结构。结果11眼达到眼表功能优秀的治疗效果,2眼良好,手术前后患者的眼表功能无明显变化。自体硬腭黏膜移植眼睑后可与残留睑板结膜良好愈合,未见有植人物感染现象:手术半年后硬腭黏膜上皮与结膜上皮结构类似,黏膜上皮内出现杯状样细胞。结论硬腭黏膜片移植联合眶周皮瓣转移是眼睑重建的良好方法,手术不影响患者的眼表功能。受眼局部微环境的影响,硬腭黏膜可能逐渐向结膜形态发生转变。
Objective To evaluate the efficacy of hard palate mucosa transplantation combined with periorbital skin flap in the treatment of eyelid full thickness defect after mechanical excision and eyelid malignancy resection and to design a retrospective case series. Thirteen patients (13 eyes) underwent eyelid full thickness defect after mechanical or eyelid resection: Methods Thirteen patients underwent palatal bland palatal mucosa transplantation combined with periorbital skin flap transfer. The patients’ palpebral fissure length, palpebral fissure height, degree of eyelid insufficiency, tear film rupture time, Schirmer Ⅰ test and corneal fluorescein staining score were recorded before and after the operation. The tissues of the implanted hard palate mucosa were harvested six months after eyelid incision School inspection. The follow-up of more than 8 months: The main indicators of surgical effects, tear film rupture time, Schirmer Ⅰ test and corneal fluorescein staining score, the histological structure of the grafted mucosa. Results 11 eyes achieved excellent therapeutic efficacy of ocular surface function, 2 eyes were good, ocular surface function of patients before and after surgery showed no significant change. There were no signs of infected plant cells after the autologous hard palate mucosa was transplanted with the eyelids. There was no infection in the infected plant tissues: the structure of the palate mucosal epithelium and conjunctival epithelium were similar in six months after operation, and goblet cells appeared in the mucosal epithelium. Conclusion The transfer of hard palate mucosa flap combined with periorbital skin flap is a good way to reconstruct eyelid. The surgery does not affect the ocular surface function of patients. Affected by the local eye micro-environment, the hard palate mucosa may gradually change to the conjunctiva morphology.